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Inter- and Intraobserver Agreement in 24-hour Combined Multiple Intraluminal Impedance and pH Measurement in Children

Pilic, Denisa*; Höfs, Carolin*; Weitmann, Sandra; Nöh, Frank; Fröhlich, Thorsten§; Skopnik, Heino; Köhler, Henrik§; Wenzl, Tobias G.; Schmidt-Choudhury, Anjona*

Journal of Pediatric Gastroenterology & Nutrition: September 2011 - Volume 53 - Issue 3 - p 255–259
doi: 10.1097/MPG.0b013e318216940e
Original Articles: Gastroenterology

Objectives: Assessment of intra- and interobserver agreement in multiple intraluminal impedance (MII) measurement between investigators from different institutions.

Methods: Twenty-four 18- to 24-hour MII tracings were randomly chosen from 4 different institutions (6 per center). Software-aided automatic analysis was performed. Each result was validated by 2 independent investigators from the 4 different centers (4 investigator combinations). For intraobserver agreement, 6 measurements were analyzed twice by the same investigator. Agreement between investigators was calculated using the Cohen kappa coefficient.

Results: Interobserver agreement: 13 measurements showed a perfect agreement (kappa >0.8); 9 had a substantial (kappa 0.61–0.8), 1 a moderate (kappa coefficient 0.41 to 0.6), and 1 a fair agreement (kappa coefficient 0.11–0.4). Median kappa value was 0.83. Intraobserver agreement: 5 tracings showed perfect and 1 showed a substantial agreement. The median kappa value was 0.88.

Conclusions: Most measurements showed substantial to perfect intra- and interobserver agreement. Still, we found a few outliers presumably caused by poorer signal quality in some tracings rather than being observer dependent. An improvement of analysis results may be achieved by using a standard analysis protocol, a standardized method for judging tracing quality, better training options for method users, and more interaction between investigators from different institutions.

*Klinik für Kinder- und Jugendmedizin, St Josef-Hospital, Universitätsklinik der Ruhr-Universität Bochum

Klinik für Kinder- und Jugendmedizin, Universitätsklinikum RWTH Aachen

Klinik für Kinder- und Jugendmedizin, Klinikum Worms

§Kinder- und Jugendklinik, Universitätsklinikum Erlangen, Germany.

Address correspondence and reprint requests to Denisa Pilic, Klinik für Kinder- und Jugendmedizin, St Josef Hospital, Universitätsklinik der Ruhr-Universitat Bochum, Alexandrinenstr 5, 44791 Bochum, Germany (e-mail:

Received 13 November, 2010

Accepted 20 February, 2011

Dr Pilic has served on the speakers’ bureau of Tecnomatix Medical; Dr Wenzl has received research support from AstraZeneca, Sandhill Scientific, and Tecnomatix Medical, has been a consultant to Sandhill Scientific, and has served on the speakers’ bureaus of Tecnomatix Medical and Reckitt Benckiser. The other authors report no conflicts of interest.

Copyright 2011 by ESPGHAN and NASPGHAN